Perimenopause is the transitional phase leading up to menopause, when a woman’s body gradually begins to produce less estrogen. It typically starts in the mid-to-late 40s but can begin earlier. During this time, hormone levels fluctuate, which can cause irregular menstrual cycles, hot flashes, sleep disturbances, mood changes, and other physical or emotional symptoms. Perimenopause can last several years and ends when a woman has gone 12 consecutive months without a menstrual period, marking the onset of menopause. With all of the hormonal changes, changes occur in your pelvic floor. Addressing the changes as they occur helps to prevent complications associated with these changes.
Introduction to the Pelvic Floor
Anatomy of the Pelvic Floor:
- The pelvic floor is a group of muscles, ligaments, and connective tissues spanning the bottom of the pelvis.
- Key muscles include:
- Ischiocavernosis and Bulbospongiosus
- Superficial and Deep Transverse Perineal, Compressor Urethra
- Levator ani group: pubococcygeus, puborectalis, iliococcygeus.
- These muscles support:
- Pelvic organs: bladder, uterus, and rectum.
- Functions: urinary and fecal continence, sexual function, and core stability.
- Pelvic organs: bladder, uterus, and rectum.
Physiology:
- Muscles contract and relax to control bladder and bowel function.
- They respond to pressure changes during movement, lifting, coughing, etc.
- Interact with abdominal and diaphragm muscles for postural and core support.
Perimenopause and Pelvic Floor Changes
Key Changes Affecting the Pelvic Floor:
- Estrogen Decline:
- Thinning of urogenital tissues.
- Decreased collagen production and tissue elasticity.
- Reduced lubrication, leading to irritation and sexual discomfort.
- Thinning of urogenital tissues.
- Loss of Muscle Mass and Tone:
- Sarcopenia impacts all skeletal muscles, including the pelvic floor.
- May lead to weakness and poor reflexive contractions.
- Sarcopenia impacts all skeletal muscles, including the pelvic floor.
- Pelvic Organ Support Changes:
- Risk of pelvic organ prolapse increases.
- Reduced bladder control—stress urinary incontinence becomes more common.
- Risk of pelvic organ prolapse increases.
- Connective Tissue Laxity:
- Ligaments and fascia lose strength, affecting organ positioning.
The Importance of Strengthening the Pelvic Floor
Why It Matters:
- Continence: Prevent or reduce urinary leakage.
- Sexual Health: Improve sensation, reduce discomfort.
- Prolapse Prevention: Support bladder, uterus, and rectum.
- Core Stability: Improve posture and reduce low back or hip pain.
- Confidence and Mental Health: Reduce anxiety and improve self-image.
Strengthening the Pelvic Floor
- Pelvic Floor Muscle Training (PFMT):
- Kegels:
- Contract the muscles you would use to stop urine flow.
- Hold for 5–10 seconds, then relax for 5–10 seconds.
- Perform 10 reps, 3 times per day.
- Avoid using glutes, abs, or thighs.
- Contract the muscles you would use to stop urine flow.
- Quick Flicks:
- Rapid contractions for urgency and reflexive strength.
- 10 fast contractions, 3 times per day.
- Rapid contractions for urgency and reflexive strength.
- Coordinated Breathing & Core Training:
- Exhale during contraction to recruit the deep core (transversus abdominis).
- Use diaphragmatic breathing to train pressure regulation.
- Functional Training:
- Engage pelvic floor during lifting, squatting, or coughing.
- Cue: “Squeeze and lift” before exertion.
- Lifestyle Modifications:
- Avoid constipation (fiber, hydration, positioning).
- Maintain a healthy weight.
- Stop smoking to reduce chronic coughing.
- Minimize high-impact exercise if symptomatic.
- When to Seek Help:
- Consult a pelvic floor physical therapist for personalized assessment.
- Symptoms such as heaviness, incontinence, or pain may need individualized intervention.
Maintenance and Progression
- Incorporate pelvic floor work into daily routine (brushing teeth, red lights, etc.).
- Progress exercises by increasing reps, holds, or integrating into full-body movement.
- Reassess function every 3–6 months with self-checks or professional input.
Conclusion
Strengthening the pelvic floor during perimenopause is a vital strategy to maintain continence, sexual health, and pelvic organ support as estrogen declines. Understanding your anatomy and using intentional, consistent exercise can dramatically improve comfort and confidence during this life phase.
Need help?
If you’re struggling with any pregnancy or postpartum concerns and want a personalized evaluation and treatment plan, make an appointment with one of the Pelvic Floor Physical Therapists at The Pelvic Health Center in Madison, NJ. We’re trained to help identify and treat the causes of your perimenopause symptoms!